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Patient Assistance Information

 
 
 
Celgene Patient Support

Celgene Corporation
Summit, NJ 07901
Phone : 800-931-8691
Fax: 800-822-2496
Eligibility
> This program is intended for patients that may have insurance, this includes Medicare Part D patients. Income requirements for this program have not been disclosed. Patient must be a US resident with prescription from US doctor.
Who Can Apply
> Anyone requesting assistance can call to request an application to me mailed, faxed or download it from the website. Application needs to be returned via fax or mail.
Required
> The doctor must complete section and sign the application. The patient must complete section, sign, attach proof of income and any insurance information. Patient and Doctor will be notified of acceptance within 24-48 hours.
Supply
> Up to 1 month supply. Patient or Doctor must contact company for refills. Company will contact patient about reapplying.
Ship To
> Doctor's office or patient's home.
Note
>
 
Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
 
Abraxane injectable suspension
Istodax injection
Pomalyst capsule
Revlimid
Thalomid (thalidomide)
Vidaza injectable; subcutaneous
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Celgene Patient Assistance Application
(Requires Acrobat Reader